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How to Increase Client Adherence


Are you frustrated by clients that do not consistently perform their exercise homework or follow your program instructions? You are not alone.

Many trainers believe that if their clients adhered to their programs more strictly they would reach their health and fitness goals. This article will help you understand why clients do not perform their program components regularly, provide strategies you can employ to help boost client adherence and teach you how to stop stressing out about clients that don’t seem to be pulling their weight.

Learning Objectives:

  1. Readers will learn why clients to not regularly adhere to their programs.
  2. Readers will learn what they can do to increase client adherence.
  3. Readers will learn what they can do to decrease their own stress regarding clients that do not adhere to a program of regular exercise.

The “F” Word

One often overlooked aspect of human behavior with respect to health and fitness programming is fear. Fear is a necessary and important emotion because it makes us wary of danger and keeps us alive. However, an underlying fear of ourselves—or more specifically fear that we are not good enough—can prevent us from engaging in (or even attempting) new actions and/or behaviors that we believe require skills that are beyond our capabilities (Grave et al., 2011).

When it comes to participating in a program of regular exercise or sticking to a nutrition plan, this lack of self-belief (and general fear of failure) is what underlies many clients’ adherence issues (Roberts, 1992). The good news is that there are many things you can do from a program design standpoint to help assuage clients’ fears, bolster their self-confidence and increase adherence.

Put Clients in Control

By and large, fitness professionals are self-motivating individuals who thrive in the controlled environment of regular health and fitness programs. They schedule their workouts, plan their food intake, set fitness goals and strive to achieve them. However, this passion for purpose can sometimes go astray when trying to empower clients to adapt the same behaviors. Many personal trainers take total control of their client’s program in an attempt to “guide” them into adapting the desired behavior(s). Unfortunately, this practice frequently flops and the client fails to adhere to the program. This is because clients are often fundamentally afraid that they do not have the necessary skills required to perform the behaviors the trainer has identified. In a short time, this anxiety becomes overwhelming and the client looks for ways to abandon their program.

Alternatively, trainers can help increase client confidence (and long-term program adherence) by helping put clients in control of their own program and create an environment where they feel safe and self-assured (Kushner, 2009). These confidence-building strategies should be introduced at the outset of a client’s program during the initial consultation phase. Ask clients what they would like to do, are currently doing, and/or are prepared to do that would help them work toward their health and fitness goals. By seeking your client’s feedback, rather than imposing your ideas upon them, they will identify program variables that they feel confident they can perform.

Now you can progress to the next stage of the program design process. This is where you use your specialty knowledge of exercise, movement, corrective strategies, nutrition, etc., to help guide the client’s self-examination to make sure the behaviors they identify (and that they are prepared to do) are indeed going to prove beneficial.

For example, imagine assisting a client in identifying program strategies to help eliminate a long-standing back pain issue. The savvy personal trainer recognizes the client’s anxiety and asks, “What have you already done (or are currently doing) that helps alleviate your back pain?”

When the client responds that they sometimes “use a foam roller to massage the muscles of their buttocks and legs when their back really gets bad,” the trainer seizes the opportunity to highlight this positive behavior and incorporate it into the client’s new exercise program. They review the way the client performs the exercise, make any necessary adjustments to their technique and further explain that these techniques (and others like them that can be integrated into their program) are extremely beneficial for both alleviating back pain and preventing it from reoccurring.

Strategies like these help the client recognize positive behaviors they already feel safe and comfortable using and, consequently, motivate them to perform them more regularly. This is a major key to long-term exercise adherence.

Small Steps to Success

Have you ever heard the joke “How do you eat an elephant?” The answer is simple. You eat it one bite at a time.

man sitting next to an elephantEating an elephant is a metaphor to help you understand how your client feels when they imagine the effort it will take to reach their health and fitness goals. For you, reaching such goals is commonplace. However, for most clients these objectives seem immense, if not completely insurmountable. Therefore, in addition to putting your clients in control of their program, it is also extremely important that you help them identify (and reinforce) very small, achievable steps as part of the process (Bandura, 1986).

When people are afraid, they sometimes want to take big steps in an attempt to get out of a scary situation quickly. When it comes to exercise, people are particularly vulnerable to an “all or nothing” state of mind. This leads them to attempt giant leaps of faith that usually prove too big and the person ultimately fails, thus setting themselves back even further (Price, 2002).

Once you have helped a client identify a positive action they can confidently integrate into their day/life, ask them how many reps (or how much time) they can pledge to that behavior/activity. Do not make the mistake of instructing them how much you think they should commit to that activity. Remember, it is in your client’s best interest for them to identify a level of commitment (and time) that does not make them feel overly anxious or frightened.

At the initial stages of the program, don’t worry that a client is not doing enough of a particular activity. As your client repeats the desired behavior regularly, their self-confidence will increase, and their comfort zone will expand accordingly (Williams, 1997). This continued repetition of desired activities will eventually produce results and the client will naturally want to invest more time in those behaviors that are helping them reach their goals.

A Few Favorite Things

When someone is scared or fearful about something, having access to familiar or favorite things can help ease their anxiety. For example, a child may hug their teddy bear in the dark to get to sleep or a person may wear a favored item of clothing in situations that make them anxious (Berdik, 2012). This notion of safety in familiarity can be integrated into the program design process to help clients assimilate new exercise/diet behaviors. Pairing the unfamiliar activities/exercises with some of their favorite things (e.g., suggesting to a client that likes to watch TV of an evening perform their self-myofascial release homework in front of the television) will help decrease their stress surrounding the new behavior and increase their adherence to performing their exercise homework regularly.

pizzasSimilarly, if you are working on the diet elements of a program with a client and they tell you that they like to eat pepperoni pizza on Friday night, do not suddenly inform them they will need to eliminate this favorite treat. This will only serve to increase their existing fear surrounding the diet portion of their program. Instead, ask them what additional types of pizza toppings they like until they identify an ingredient that is a vegetable (or lower in calories) like mushrooms, green peppers, pineapple, or black olives. Then ask them if they would consider adding one or more of those toppings to the pizza they already enjoy.

This strategy enables your client to maintain a feeling of control over what they eat and satisfied that they are getting what they want. This technique also introduces positive behaviors that will eventually help your client reach their goals. In fact, as their taste buds change over the coming weeks/months this client may consider replacing pepperoni altogether in favor of less caloric topping choices. However, such a big change is only possible if at first your client feels comfortable and/or confident that they can take these initial first steps. Eventually, repetition of these small steps will lead to adaptation of the preferred behavior and ultimate goal attainment.

Watch the below video for more information on why clients don’t do their exercise homework:

Don’t Project Your Own Insecurities

It is natural for fitness professionals to get extremely frustrated when their clients do not adhere to their programs. Personal trainers like to see their clients succeed; however, the truth is that these feelings of irritation that surface when clients don’t follow their programs stems from the same underlying fear that clients face of not being good enough (Freud, 1937). If their clients don’t succeed, trainers believe that this reflects poorly on their skills/abilities as a fitness professional. Recognizing that you too are subject to doubts and fears with respect to your clients’ program can help you step back and become more conscious of your own role in the design process. This will help lessen your feelings of frustration that come about as a result of you projecting all the blame onto clients for their lack of adherence.

You can also reduce your own anxiety by acting as a facilitator rather than a dictator in your role as a trainer. While a dictator has total power over a situation, they are also solely responsible for the outcome of that situation – both the good and the bad. By adopting a facilitator approach to your work you can empower clients to control their own programs, which transfers responsibility to them, making them more intrinsically involved in the outcome. This strategy also increases client confidence and ensures positive behaviors will be repeated while simultaneously decreasing your own involvement (and obsession and stress) surrounding ongoing program adherence.

References

Bandura, Albert. 1986.  Social Foundations of Thought and Action: A Social Cognitive Theory.  Englewood Cliffs, NJ: Prentice Hall.

Berdik, Chris. 2012. Mind Over Mind: The Surprising Power of Expectations. New York: Penguin.

Freud, A. (1937). The Ego and the mechanisms of defense, London: Hogarth Press and Institute of Psycho-Analysis.

Grave, R. D., Calugi, S., Centis, E., El Ghoch, M., & Marchesini, G. (2011). Cognitive-Behavioral Strategies to Increase the Adherence to Exercise in the Management of Obesity. Retrieved August 1, 2016, from https://www.hindawi.com/journals/jobe/2011/348293/

Kushner, Harold. 2009. Conquering Fear. New York: Anchor Books.

Price, Justin. (2002). Taking A Leap of Faith. IDEA Fitness Journal. San Diego: IDEA Health and Fitness Association.

Roberts, Glyn. 1992. Motivation in Sport and Exercise. Champaign, IL: Human Kinetics.

Williams, J. 1993. Applied Sport Psychology: Personal Growth to Peak Performance (2nd Edition). Mountain View, CA: Mayfield Publishing.